Southdale Periodontics, PLLC
NPI 1134547730ActiveOrganization· Dentist, Periodontics· Edina, MN
Dentist, Periodontics in Edina, Minnesota, registered in NPPES in April 2014. The authorized official on file is Russell Allen Dylla, D.D.S., Owner.
Overview
| NPI | 1134547730 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Apr 1, 2014 |
| Last updated in NPPES | Apr 1, 2014 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, Periodontics Primary | 1223P0300X | D12016 | MN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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